Confessions of a Data Quality Manager

Transcription

1 Confessions of a Data Quality Manager FCDS Annual Conference Boca Raton, Florida 7/28/2016 Steven Peace, CTR

2 Outline 20 Data Quality Issues in 45 Minutes

3 Reference Dates & Accession Numbers FCDS Reference Date & FCDS Acc # 01/01/1981 FCDS Reference Date FCDS Reference Date Never Changes CoC Reference Date & Facility Acc # 1930-Today - CoC Reference Date CoC Reference Date Can Be Changed FCDS has cases from your facility going back to 01/01/1981 admissions FCDS Facility/Accession # FCDS Facility/Accession Never Changes even if you scrap your facility database or change your CoC Reference Date Your Facility/Accession # Must Match the FCDS Facility Accession # of old Facility Reference Date for FCDS 01/01/1981 Hospitals 07/01/1997 Ambi Dx/Tx Centers 07/01/1997 Pathology Labs Your Facility/Accession # Must Match the Original (old) FCDS Facility Accession # Only the Sequence # Changes

4 RQRS Case Reported to FCDS When to Send Abstract to FCDS Transmit Data at Least Quarterly Facilities Reporting >500 Cases SHOULD Transmit Data Monthly DO NOT SEND INCOMPLETE (Active) RQRS CASES TO FCDS Send Case to FCDS when; All First Course Therapy Completed Six Month Reporting Requirement FCDS Annual Deadline FCDS Has No Update Abstract Tool Cases sent to FCDS without all first course therapy do not have another opportunity to get updated from your facility. Any additional first course treatment never will get to FCDS and the case looks incomplete. Any other critical case updates will never get to FCDS, either.

5 Text Requirements Apply to ALL Cases You must ensure that all coded values are supported by text Overuse and Misuse of Abbreviations is Worse than Ever and is being Monitored TAKE YOU TIME & BE CAUTIOUS! ALWAYS cancer description at first presentation, symptoms, cancer(s) history, why was patient at the facility ALWAYS description of patient - 75yr old Cuban male, 64 yr old black female, 49 yr old Haitian male ALWAYS Dates of lab tests, scans and imaging studies, oscopy, biopsy, surgery, staging, pathology for all tissue examined, and ALL treatment Goal: a full chronology of care from diagnosis to present ALWAYS Include Positive and Negative findings from surgery, imaging, staging procedures, pathology, clinical exam

6 Class of Case 32 and Text Requirements You must provide a chronology of care diagnosis to current ALWAYS INCLUDE cancer description at first presentation, symptoms, cancer(s) history, why was patient at the facility ALWAYS INCLUDE description of patient - 75yr old Cuban male, 64 yr old black female, 49 yr old Haitian male ALWAYS INCLUDE Dates of lab tests, scans and imaging studies, oscopy, biopsy, surgery, staging, pathology for all tissue examined, and ALL treatment.

7 Non-Analytic Case First Course Tx Elsewhere Still need to document and code all first course treatment (including active surveillance) as well as complete staging even when your facility was not involved in the original dx or tx or when all your facility does is diagnose the cancer. This includes treatment for palliation-only. Palliative chemo, surgery, and radiation are still cancer treatment, even if not intended to cure. If it is first course document it and code it. CoC may not require that you complete information on Non- Analytic Cases but FCDS does require complete text and tx.

8 Patient Demographics Even Require Text Transposed First and Last Name Hispanic and Multiple Surname Sex Coding Errors Sex - Reproductive Cancers Sex - Non-Reproductive Cancers Sex - Gender Identity & Transition Sex - Unusual first names Errors Still Increasing - Over 5 Years Registrars still not checking Use Name Check Validation Edit Failures will be validated Edit Failures need Force

9 Date of Diagnosis: By Imaging or Pathology?

10 Is it really an unknown primary? Why? C80.9 or C76.* as Seq 01-Historical C80.9 & History of Other Cancer(s)

11 Epidemic of NOS and Ill-Defined Codes Use Registrars coding NOS frequently for some reason This Not Acceptable Especially on Analytic Cases Document AND Code the Most Specific Available Increases in Unknown Primary & Ill-Defined Site Primary Site, NOS when subsite is known Histology, NOS when specific subtype is known Increases in Unknown Stage and Unknown Biomarkers Surgery, NOS codes of 80, 90 are meaningless Radiation, NOS Chemo, NOS

12 Correct Use of 2014 Grade Coding Instructions

13 # Nodes Examined & # Nodes Positive 98/00 or 00/98 they are different 00 = Nodes Examined 98 = Nodes Positive They are different!! Coding 99/99 when no surgery done If no surgery performed 00 = Nodes Examined 98 = Nodes Positive How are these different?

14 Where is Your Decimal Point? Tumor Size (XXXmm) Depth of Invasion (X.XXmm) PSA (XX.Xng/ml) Depth of Invasion Melanoma Prostate PSA Value (XX.X ng/ml) SSF Code Depth Invasion Units mm mm mm mm mm SSF Code PSA Value Units ng/ml ng/ml ng/ml ng/ml ng/ml ng/ml

15 Coding Surgery Fields Correctly Surgery of Primary Site Surg, NOS Surgery of Other, Regional, Distant Was tissue removed en bloc with primary site or regional surgery? Was the removal incidental? Was the removal to remove cancerous tissue? Was the removal a debulking? Do not double-code the surgery Do not code surgery if not to remove suspected cancerous tissue or known cancerous tissue

16 Coding Anti-Neoplastic Agents SEER*Rx Chemo Regimens List All Agents If you do not know which drugs are included look it up!!! Many protocols mix multiple classes of agents such as chemo, hormones, and immunotherapy Some protocols include drugs/ agents plus other types of therapy such as radiation or BMT COG-A3973 is not good enough BRM/Immunotherapy Critical Class Do Not Guess by Name of Agent Rituximab - Trastuzumab Herceptin - Bevacizumab Revlimid - Panitumumab Crizotinib - Pertuzumab Alectinib - Ipilimumab Ceritinib - Keytruda BCG - Darzalex Levamisole - Lenalidomide

17 Coding New Radiation Delivery Methods New Intra-Operative Radiotherapy Intrabeam IORT MammoSite - TARGIT All are brachytherapy modality Target Dose often single dose Can be high-dose or low-dose Low dose as low as 50 kv High dose as much as 2000cGy Treatment to primary tumor bed Place balloon catheter or Place 1 or a few Targets in bed Glass or Gold Bead(s) are Target Target absorbs the radiation

18 Talk about Miniature Sample x-ray Sources and tcr.amegroups.com

19 Questions Work in his Future Office